clinical food, fluid and nutritional care policy · 2.2 protocol for the implementation of proteced...

Clinical

Food, Fluid and Nutritional Care Policy

SECTION 2: PLANNING AND DELIVERY OF FOOD AND FLUID IN HOSPITALS

2.2 PROTOCOL FOR THE IMPLEMENTATION OF PROTECTED MEALTIMES

IN HOSPITALS

Policy Manager

Joyce Thompson Dietetic Consultant in Public Health Nutrition

Policy Group

Food Fluid & Nutritional Care (FFNC) Policy Review Group

Policy Established

Policy Review Period/Expiry

31 May 2018

Last Updated

14 January 2016

This policy does / does not apply to Medical / Dental Staff (delete as appropriate)

UNCONTROLLED WHEN PRINTED

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Document: NHS Tayside FFNC Policy Section 2.2 Version: 8.1 Version Date: Dec 2015

Policy Manager: Joyce Thompson, Dietetic Consultant in PH Nutrition of 18 Review Date: May 2018

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Version Number

Purpose/Change Author Date

1.0 First draft Kerry Queen/ Victoria Hampson/ Caroline McKenzie

28/08/2012

2.0 Changes made following Expert Consultation

Caroline McKenzie/ Victoria Hampson

19/09/2012

3.0 Changes made following Universal Consultation

Victoria Hampson/ Kerry Queen

03/12/2012

4.0 Formatting

Lorna Murray 04/2013

4.1 Formatting

Sue Smart 29/07/2013

5.0 Update to Appendix 7

Kerry Queen 22/08/2013





8.0 Changes made following Expert Consultation/ removal Appendix 7


8.1 Final update, removal Appendix 6/ formatting

Kerry Queen/ Sue Smart

14/01/2016

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CONTENTS

SECTION 2: 2.2 Page Number

1. PURPOSE AND SCOPE 5

2. RESPONSIBILITIES AND ORGANISATIONAL ARRANGEMENTS 5

3. BACKGROUND 5

4. ROLES AND RESPONSIBILITIES 6

4.1 Senior Charge Nurse 6

4.2 Qualified Nursing Staff 6

4.3 Non-registered Nursing Staff 7

4.4 Ward Assistants 7

4.5 Medical Staff Responsibilities 8

4.6 Allied Health Professionals (AHP’s) Responsibilities 8

4.7 Phlebotomy Services 8

4.8 Support Services 8

5. CONSENT 8

6. AUTHORISED PROFESSIONALS 8

7. EDUCATION AND TRAINING 9

8. LEGAL LIABILITY 9

9. REFERENCES 9

STANDARD OPERATING PROCEDURE 2.2.1 - Implementation of Protected Mealtimes

10 - 11

APPENDIX 1 - Protected Mealtimes Ward Poster 12

APPENDIX 2 - Making Meals Matter 13

APPENDIX 3 - Principles of Safe and Effective Nutritional Care 14

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APPENDIX 4 - Principles of Protected Mealtimes 15

APPENDIX 5 - Observation Tool – Protected Mealtimes 16 - 18

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2.2 PROTOCOL FOR THE IMPLEMENTATION OF PROTECED MEALTIMES IN HOSPITAL

1. PURPOSE AND SCOPE The Protected Mealtime’s protocol aims to improve the mealtime experience by:

allowing patients to eat meals without unnecessary interruption

supporting clinical staff to prioritise mealtimes

providing an environment conducive to eating

offering assistance with eating and drinking to those that require it The protocol applies to all adult in-patient areas within NHS Tayside however for the following areas e.g. Accident and Emergency, Intensive Care and Medical & Surgical Admission Units exceptions may apply.

2. RESPONSIBILITIES AND ORGANISATIONAL ARRANGEMENTS General Managers/Assistant Directors (or equivalent) are responsible for distributing this protocol to staff within their area/directorate/business unit, ensuring that staff have the opportunity to access the Food, Fluid and Nutritional Care Policy. Clinical Directors, Senior Charge Nurses, District Nurse Clinical Team Leaders, Mental Health Managers are responsible for ensuring that this protocol is implemented within their area and for monitoring compliance with best practice during mealtimes.

3. BACKGROUND In 2003 the NHS Quality Improvement Scotland (QIS) Standards for Food, Fluid and Nutritional Care in Hospitals (FFNCH) were published and revised in October 2014, mandating that all Health Boards implement “Protected Mealtimes”. The overarching principle of Protected Mealtimes is to support clinical staff to implement processes to reduce all “non-essential activity (clinical and non-clinical) during mealtimes” in order to improve the patient experience and provide care that is both safe and effective (NHS QIS 2003). In addition Protected Mealtimes supports clinical staff to:

create a quiet and relaxed atmosphere in which patients/clients are able to enjoy meals

limit unwanted traffic through the ward and unit during mealtimes, e.g. estates work/ linen deliveries/domestic cleaning

recognise and support the social aspects of eating

limit non-essential clinical and non-clinical ward based activities

and emphasise to all staff, patients and visitors the importance of mealtimes as part of care and treatment for patients/clients

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Carers and families or friends should be actively encouraged to assist with eating and drinking at mealtimes if the patient requires assistance or encouragement to eat and drink. However discretion should be used to limit the number of persons attending to minimise the impact this may have on other patients.

4. ROLES AND RESPONSIBILITIES

4.1 Senior Charge Nurse

Ensure that the maximum number of registered and non-registered nursing staff is available to assist in the distribution and delivery of food, taking into account staff meal breaks

Determine when and for how long the ward/unit will close to allow for Protected Mealtimes

Ensure that the Healthcare Improvement Scotland (HIS) national “Making Meals Matter” posters (adapted by NHS Tayside) are visible to staff and visitors and displayed at the entrance to each ward area

Ensure that “Your Food and Drinks in Hospital” patient information leaflet is available, to give to patients, relatives or carers or friends on admission

Enable and actively encourage patients/clients who need assistance to eat and drink to have relatives/carers or a friend present during mealtimes to assist with eating and drinking

Liaise with all staff and make them aware of times and the principles of Protected Mealtimes

Ensure that other ward processes such as care rounds and medicine rounds are not negatively affecting mealtime experience

4.2 Qualified Nursing Staff

Before mealtimes:

Ensure that patients requiring assistance with eating and drinking are identified to all staff including volunteers using the safety brief and or handovers

Ensure patients that do need assistance to eat and drink have their meals delivered on a peach tray (if in use) to signify to the care team their need for assistance

The nurse in charge of each shift will organise staff breaks to maximise the number of registered and non-registered staff available to deliver and assist patients/clients

Provide patients with assistance to use the toilet prior to the service of food, if required

Provide patients with assistance to wash their hands or alternatively be provided with hand wipes

Ensure bed tables and eating areas are clean and tidy prior to meals being delivered

Ensure patients/clients are made comfortable and in a safe position prior to eating

During mealtimes:

Give out meal trays

Ensure food is served within easy reach of the patient/client

Offer tea/ coffee and refreshments

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Provide assistance and/or encouragement to patients/clients to eat and drink

Avoid routine administration of medicine (unless prescribed / required to be taken with meals)

Avoid recording observations in clinically stable patients/clients

Offer condiments at each mealtime e.g. salt, pepper After mealtimes:

Collect meal trays, (ensuring that all clinical debris/equipment has been removed e.g. medicine pots prior to returning to the catering department)

A full and accurate record food intake on Food Record Charts (if in use)

A full and accurate record fluid intake on Fluid Balance Charts (if in use)

Encourage patients to keep their snack for between meals, these can be removed from trays prior to the distribution to patients and kept in the ward kitchen and given out to patients either mid morning or mid afternoon and evening

4.3 Non- registered Nursing Staff

Before mealtimes:

Provide patients with assistance to use the toilet prior to the service of food if required


Ensure bed tables and eating areas are clean and tidy

Ensure patients/clients are made comfortable and in a safe position prior to the eating

During mealtimes:

Give out meal trays



Provide assistance and/or encouragement to patients/clients to eat and drink

Avoid recording observations in clinically stable patients/clients

Avoid answering the telephones

Offer condiments at each mealtime e.g. salt, pepper After mealtimes:


Accurately record food intake on Food Record Charts (if in use)

Accurately record fluid intake on Fluid Balance Charts (if in use)

Encouraged patients to keep their snack for between meals

4.4 Ward Assistants Before mealtimes:


Ensure bed tables and eating areas are clean and tidy During mealtimes:

Give out meal trays


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Offer condiments at each mealtime e.g. salt, pepper


Answer the telephones and prioritise calls to ensure nursing staff are not interrupted during mealtimes

After mealtimes:


4.5 Medical Staff Responsibilities

Nutritional care depends on teamwork between health care workers in different disciplines, the scope and contribution of whose work should be recognised, (Royal College of Physicians, 2002), thus doctors can help promote nutrition for patients/clients by making sure that as far as possible:

The service and consumption of meals is not interrupted by ward rounds or routine tasks which could take place at other times

Procedures, such as clinical tests, are scheduled to ensure, whenever possible, that patients do not miss meals. The routines of some professional staff may have to be adjusted, such as the timings of ward rounds.

4.6 Allied Health Professionals (AHPs) Responsibilities

Routine assessments and treatments by Allied Health Professionals (AHP) will not take place during the period of Protected Mealtimes when they do not contribute to the nutritional care of patients/clients.

4.7 Phlebotomy Services Routine blood taking from patients/clients will not take place during the period of Protected Mealtimes unless been agreed by the Senior Charge Nurse.

4.8 Support Services Routine cleaning of patient/clients bays, cubicles or rooms will not take place during the period of Protected Mealtimes.

5. CONSENT Verbal consent is required when providing assistance to eat and drink. (Refer to NHS Tayside Informed Consent Policy, 2011).

6. AUTHORISED PROFESSIONALS All staff within NHS Tayside applying the Protected Mealtimes must at all times act in accordance with their respective professional code of practice.

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7. EDUCATION AND TRAINING In order to ensure good practice and minimise risk, staff must be familiar in the above processes. No formal training is required for this procedure although staff should continually reflect upon their own skills and knowledge. All In-patient areas will display the Healthcare Improvement Scotland “Making Meals Matter” posters in relation to Protected Mealtimes (Appendix 1, 2 and 3) and adhere to the principles within safe and effective nutritional care (HIS, 2011). Nutrition Link Nurses/Nursing staff will undertake the Healthcare Improvement Scotland Observational Tool (adapted by NHS Tayside) (Appendix 5), weekly until compliance > 95% and monthly thereafter to ensure Protected Mealtimes processes are being implemented and adhered to. Protected Mealtimes Information is available for patients in “Your Food and Drinks in Hospital” leaflet.

8. LEGAL LIABILITY NHS Tayside as an employer will assume vicarious liability for the actions of all staff, including those on honorary contracts, providing that:

Staff have undergone any training identified as necessary for the process

The member of staff is authorised by NHS Tayside to undertake the process

The provision of this protocol and the supporting procedure has been followed by the member of staff at all times

9. REFERENCES BAPEN (2007) Organisation of Food and Nutritional Support in Hospital Health Improvement Scotland (2011) Improving Nutrition - Improving Care Programme. Health Improvement Scotland NHS Quality Improvement Scotland 2014. Clinical Standards: Food, Fluid and Nutritional Care in Hospital. [Online] Available at: www.healthcareimprovementscotland.org NHS Tayside (2015) Infection Prevention and Control Policy NHS Tayside (2014) Informed Consent Policy NHS Tayside (2013) Record Keeping Policy Nursing and Midwifery Council (NMC) (2015) The Code: Professional standards of practice and behaviour for nurses and midwives Royal College of Physicians (2002) Nutrition and Patients: A doctor's responsibility. London Royal College of Nursing (RCN) (2007) Principles of nutrition and hydration. London

http://www.healthcareimprovementscotland.org/

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2.2.1 STANDARD OPERATING PROCEDURE - Implementation of Protected Mealtimes

Policy: Food, Fluid & Nutritional Care

Policy Reference: 2.2.1

Originator: Kerry Queen/ Victoria Hampson

Operation

Implementation of Protected Mealtimes

Part Number/ Name

This procedure is for implementation of Protected Mealtimes within hospital

Safety Tools/ Clothing

Universal Precautions Blue Aprons

Tools/ Equipment

No Main Operating Steps Rationale Evidence/support

1 At the start of each shift all patients nutritionally at risk are identified and this information is included in handover and the “safety brief”

To ensure that all nursing staff are aware of patients nutritionally at risk

NMC The Code (2015)

2 Ensure the maximum number of nursing staff are available to distribute meals and assist patients who require help with eating and drinking

All nursing staff have a responsibility to and are accountable for to ensuring that nutrition and hydration needs are met in patients

Royal College of Nursing (2007)

3 Clear and wipe bed tables prior to the service of meals

To minimise infection NHS Tayside Infection Control Policy (2015)

4 Offer/provide assistance to use the toilet prior to the service of foods

Person centeredness NMC The Code (2015)

5 Encourage patient/clients to wash their hands before meals and help those who are unable to wash their hands themselves

To minimise infection risk

NHS Tayside Infection Prevention and Control Policy (2015)

6 Position patients/clients appropriately to enable them to eat and drink safely

To improve patient safety/comfort

7 Provide appropriate tray, cutlery and crockery at each mealtime, ensuring that these are within easy reach

To enable the patient to safely eat and drink using appropriate aids identified as necessary

QIS (2003)

8 Offer condiments e.g. salt / pepper at each mealtime

Patient choice/ person centredness

9 All staff will wash their hands prior to the service of mealtimes as per universal precautions

To prevent infection/ cross contamination


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10 Blue disposable aprons will be worn by all staff that are involved in the meal service

To prevent cross infection


11 All nursing staff will provide assistance and/or encouragement to patients/clients to eat, being aware of how much food is eaten and identifying patients/clients nutritionally at risk

Improve nutritional status of patients/ reduce risk of malnutrition

BAPEN (2007)

12 Food and fluid charts should be fully and accurately completed as soon as possible after the mealtime service has ended

Accurate record keeping

NHS Tayside Record Keeping Policy (2013) NMC The Code (2015)

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APPENDIX 1: Protected Mealtimes Ward Poster

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APPENDIX 2: Making Meals Matter

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APPENDIX 3: Principles of Safe and Effective Nutritional Care

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APPENDIX 4: Principles of Protected Mealtimes

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APPENDIX 5: Observation Tool: Protected Mealtimes

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